It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Sunday, December 04, 2022
Community pharmacy-led vaccination scheme helped thousands of patients overcome hesitancy around Covid-19 jabs, Kingston University London research finds
Award-winning scheme saw community pharmacists support patients to understand the benefits of being jabbed against Covid-19
An award-winning scheme that saw community pharmacists support patients to understand the benefits of being jabbed against Covid-19 and overcome initial hesitancy proved hugely successful, new research by an expert from Kingston University has shown.
The Covid Champion scheme was launched by the NHS South East London Integrated Care System in July last year, at a time when there was high prevalence of the virus in areas of South London as well as low vaccination uptake. During a six-month period, more than 8,500 conversations took place between community pharmacy professionals and patients as part of the scheme. After discussing their concerns and asking questions they may have had about the vaccine and why it was important, more than 6,000 took up the offer of a jab, including more than 2,000 previously hesitant patients.
The programme, run in the boroughs of Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark, and its effectiveness have been evaluated by Associate Professor of Pharmacy Practice at Kingston University, Dr Ricarda Micallef – with her findings published in MDPI’s Pharmacy Journal.
Dr Micallef said the project, which picked up an innovation and best practice award at the NHS’s annual PrescQIPP awards, found a lack of understanding of the vaccination was the biggest reason for patients’ initial hesitance – while cultural issues and risk of blood clots were also factors. “Many of the people the pharmacy teams spoke to felt they didn’t have enough information about the vaccine, couldn’t understand how it could be developed in that time-frame and be safe to administer so quickly – there was a lot of scepticism,” she said.
The scheme gave community pharmacists the opportunity to chat to patients about the Covid-19 vaccine while buying over the counter medicine or collecting a prescription from their local pharmacy. This enabled them to identify those who hadn’t been vaccinated, to debunk myths and misconceptions, answer any questions they may have and, with consent, book patients in for their first dose or signpost them to their local walk-in centre.
Dr Micallef said the trust people have in their local pharmacists was key to the success of the scheme. “Around 95 per cent of people in the UK can get to a community pharmacy within a 20-minute walk, so they are easily accessible. Because of this a lot of community pharmacists have really good relationships with residents in their area so I think that element of trust between patient and pharmacist really helped in terms of health messaging,” she said.
In addition to the work around increasing Covid-19 vaccine uptake rates, the scheme also saw NHS South East London work with Local Pharmaceutical Committees on a virtual community wellness outreach programme to support those most vulnerable in their communities. Pharmacists discussed self-care and how to improve physical and mental wellness with patients in a bid to reduce health inequalities across South East London.
The recognition for the project – also shortlisted for Health Initiative of the Year at the Chemist and Druggist Awards – highlighted the often unrecognised and undervalued work of pharmacists, Dr Micallef said. “This innovative and timely scheme really demonstrates the value of trusted relationships between communities and health professionals. It’s a fantastic example of the role community pharmacists have to play in healthcare, with their many wide-ranging skills and knowledge of their patients’ needs and concerns that can support ongoing public health initiatives.”
PITTSBURGH, Nov. 28, 2022 – States that legalized recreational cannabis saw a slight population-level uptick in alcohol consumption that was largely driven by young adults and men, according to new research by University of Pittsburgh School of Public Health policy scientists.
The increase in alcohol use, recently reported in JAMA Health Forum, suggests that states that legalize recreational cannabis should also consider targeted public health messaging around alcohol and other policy interventions aimed at mitigating problem drinking.
“Recreational cannabis laws have made cannabis legally accessible to nearly half of U.S. adults, but it has been unclear how this affects the use of other substances, such as alcohol,” said senior author Coleman Drake, Ph.D., assistant professor in the Department of Health Policy and Management at Pitt Public Health. “It appears that cannabis use increases the probability that people drink, at least in the three years after legalization.”
The survey inquired about any alcohol use, binge drinking and heavy drinking within the last month, and the researchers looked at differences in responses before and after recreational cannabis legalization.
Any drinking – measured as having “at least one drink of any alcoholic beverage” in the past month – increased by 1.2 percentage points in the first year after recreational cannabis was legalized, but diminished in the following two years. There was no change in binge or heavy drinking in the overall population.
When the team dove into the data, they found that the increase was driven by adults ages 18 to 24 who had a 3.7 percentage point increase in any drinking. None of the other age groups had a statistically significant increase in any drinking after cannabis legalization.
Demographically, the increase was also associated with men, non-Hispanic whites and people without some college education.
While recreational cannabis legalization was linked to a small increase in alcohol consumption, the team did not find any evidence of sustained effects on binge or heavy drinking. However, Drake noted that cannabis use has nearly doubled over the past decade, and a prior study estimated that, between 2011 and 2015, excessive alcohol use resulted in the death of over 93,000 Americans per year.
“So, it will be important to monitor whether recreational cannabis laws cause increases in drinking over longer periods of time, particularly among younger adults and men,” he said.
By zeroing in on the groups of people who may be most likely to increase risky behaviors, such as drinking more while using cannabis, states can proactively engage those communities and look for ways to mitigate risk – such as through public health campaigns or alcohol tax strategies – before recreational cannabis laws go into effect, Drake explained.
“In prior work, I found that recreational cannabis laws temporarily reduced opioid-related emergency department visits,” Drake said. “So, I would resist characterizations of cannabis legalization as categorically good or bad. We need to learn more about how cannabis legalization affects all substance use, health, and non-health outcomes, such as drug-related arrest rates, work-related injuries and labor market outcomes. Policymakers should try to think through all these costs and benefits as they consider passing recreational cannabis laws.”
Additional authors on this study are Vandana Macha, of Pitt; and Rahi Abouk, Ph.D., of William Paterson University in Wayne, N.J.
About the University of Pittsburgh School of Public Health
Founded in 1948, the University of Pittsburgh School of Public Health is a top-ranked institution of seven academic departments partnering with stakeholders locally and globally to create, implement and disseminate innovative public health research and practice. With hands-on and high-tech instruction, Pitt Public Health trains a diverse community of students to become public health leaders who counter persistent population health problems and inequities.
IMAGE: A NEW STUDY BY RESEARCHERS FROM JAPAN PRESENTS THE FIRST EVIDENCE DEMONSTRATING THE ERGOGENIC EFFECTS OF CAFFEINE ON THE 100-METER SPRINT RUNNING PERFORMANCE. WHILE BOOSTING THE SPRINT RUNNING TIME DURING THE EARLY STAGES OF RACE, CAFFEINE CONTRIBUTED TO SIGNIFICANTLY REDUCED SPRINT RUNNING TIMES AMONG ATHLETESview more
CREDIT: PROFESSOR TAKESHI HASHIMOTO FROM RITSUMEIKAN UNIVERSITY
At the international level of sport, even the smallest advantage can take an athlete from being a mere participant to a podium finisher. Consequently, athletes try to achieve that competitive edge with the help of performance enhancing training methods and pre-event performance enhancing aids. Caffeine, a nervous system stimulant, is one such performance enhancing aid, most commonly and popularly used by athletes around the world. In fact, the International Association of Athletics Federations(now called World Athletics, WA) recommends caffeine as an ergogenic (or physical performance-enhancing) aid in a consensus statement of nutritional strategy for athletics. However, owing to the absence of research on caffeine’s effects on sprint performance, the recommendation is reflective of evidence from other anaerobic sports rather than sprint running in athletics, like the 100-m sprint event.
To advance research, a team of researchers from Japan investigated the acute effects of caffeine supplementation on sprint running performance. This study, led by Professor Takeshi Hashimoto from Ritsumeikan University in Japan, was subsequently published in the Medicine & Science in Sports & Exercise journal. According to Prof. Hashimoto, “While previous studies have investigated the effects of caffeine on running activity, evidence from these studies is not conclusive enough to support the World Athletics consensus. A majority of them have looked at its effects on single sprint runs of less than 60 meters. Therefore, it was important to study the ergogenic effects of caffeine on the 100-meter sprint performance.”
The researchers recruited 13 male collegiate sprinters for the study. In a preliminary test, the researchers determined the time it takes for each athlete to reach peak blood plasma caffeine concentration after ingesting it. Taking this into account, the athletes were called two more times for 100-meter time trials after ingesting either caffeine or placebo supplements.
As measures of performance, the researchers measured the sprint velocity and calculated the sprint time. On discounting the effects of environmental factors, the corrected sprint time was used to examine the effects of caffeine supplementation.
The results revealed that the corrected 100-m sprint time was shortened significantly for athletes who received caffeine, with a decrease of 0.14 seconds compared to the controls. This decrease in the time was largely associated with a decrease in sprint time for the first 60 meters of the sprint.
The researchers also found that the mean sprint velocity for the 0–10 m and 10–20 m splits was significantly higher in the athletes who received caffeine. Moreover, no significant difference was seen in the sprint time for the last 40 meters of the sprint, despite the shortening of the sprint time in the first 60 meters. Together, these observations suggest that the caffeine supplementation provided more explosive acceleration to the sprinters in the early stage of the race.
In the long term, these results could translate to the enhancement of sports performance for athletes by enhancing the usage of caffeine as an ergogenic aid during sprints.
“The insights gained from this study have given us the first direct evidence of caffeine’s ergogenicity on sprint running in athletics. This also serves as evidence to directly support the recommendations for caffeine usage by World Athletics. The study thus provides one more advantage that athletes can use to inch themselves closer towards victory”, concludes Prof. Hashimoto.
Determined to explore the ergogenic effects of caffeine further, Prof. Hashimoto and his team intend to call to question the mechanisms behind the effects of caffeine on ballistic actions such as sprinting and jumping.
About Ritsumeikan University, Japan Ritsumeikan University is one of the most prestigious private universities in Japan. Its main campus is in Kyoto, where inspiring settings await researchers. With an unwavering objective to generate social symbiotic values and emergent talents, it aims to emerge as a next-generation research university. It will enhance researcher potential by providing support best suited to the needs of young and leading researchers, according to their career stage. Ritsumeikan University also endeavors to build a global research network as a “knowledge node” and disseminate achievements internationally, thereby contributing to the resolution of social/humanistic issues through interdisciplinary research and social implementation.
About Professor Takeshi Hashimoto from Ritsumeikan University, Japan Prof. Takeshi Hashimoto is a professor at the Department of Sport and Health Science, Ritsumeikan University. He completed his PhD in human and environmental studies from Kyoto University in 2004. Professor Hashimoto has more than 20 years of research experience and is interested in topics like energy metabolism, sports science, clinical pharmacy, and physiology among others. He has published over 80 international papers and has received 7 academic awards for his research and academic contribution.
Funding information This study was supported by Grant-in-Aid for Scientific Research from the Japanese Ministry of Education, Culture, Sports, Science, and Technology (grant no. 21H03384 to T. H.).
IMAGE: FROM MORE TRANSPARENT AI TO BETTER MRI TECHNOLOGY AND SAFER ROBOTS, USC RESEARCH IS ADVANCING THE STATE-OF-THE-ART IN MACHINE LEARNING AT NEURIPS 2022.view more
James Enouen (University of Southern California); Yan Liu (University of Southern California)
What is your paper about? The paper focuses on making AI systems more interpretable and trustworthy. Currently, we feed these algorithms a lot of data and hope that they learn the right thing. Unfortunately, they can pick up the wrong things (biases, correlations, etc.) and we might have no way of knowing. Therefore, this work is one step towards making these AI insights more interpretable and digestible to allow a human to check in with the algorithm.
Who could benefit from this research? People who want to understand “the algorithm” or “black box”; doctors who want to understand the AI systems making predictions on their patients; credit auditors; people with stakeholders who are required to explain their decisions.
Varun Bhatt (University of Southern California); Bryon Tjanaka (University of Southern California); Matthew Christopher Fontaine (University of Southern California); Stefanos Nikolaidis (University of Southern California)
What is your paper about? In July 2022, a chess-playing robot grabbed and broke the finger of a seven-year-old boy since it mistook the finger to be a chess piece. It seems like the robot assumed the human opponent to always wait in between moves and was not tested in situations where the human made the moves quickly. This accident could have been avoided if such a scenario was found during testing. Accidents like these are why we wanted to create a method of efficiently finding corner cases involving robots or other intelligent agents. In this paper, we use machine learning to predict how our robot will behave in a given scenario and greatly speed up the process of finding failure scenarios. This allows us to find very complex scenarios relatively quickly that break complex agents.
Who could benefit from this research? Manufacturers of robots, self-driving cars, etc. to better test the agents before deploying them in the real world. Better testing leads to safer robots, which also benefits the end-users.
Yizhou Zhang (University of Southern California); Defu Cao (University of Southern California); Yan Liu (University of Southern California)
What is your paper about? The research helps us better understand how fake news and rumors change people’s ideas. We apply our model to a real-world dataset of social media posts and engagements about COVID-19 vaccines. The experimental results indicate that our model recognized an identifiable causal effect of misinformation that hurts people’s subjective emotions toward vaccines.
Who could benefit from this research? Journalists can use our models to understand how fake news and rumors change people’s ideas and then find better ways to clarify the misleading content.
Zalan Fabian (University of Southern California); Berk Tinaz (University of Southern California); Mahdi Soltanolkotabi (University of Southern California)
What is this paper about? In this work, the team proposes a deep learning algorithm that can reconstruct very high-quality MRI images from accelerated scans. MRI is one of the most popular and powerful medical imaging modalities. However, scans can take significantly longer than other diagnostic methods such as CT scans. Existing methods to accelerate MRI scans take fewer measurements of the body, which leads to degraded image quality. Modern data-driven AI techniques have been successfully deployed to reconstruct MR images from accelerated measurements, but their performance has plateaued in recent years. The team’s novel method combines the efficiency of traditional convolutional neural networks with the power of transformer-based architectures recently proposed for vision applications, establishing a new state-of-the-art in accelerated MRI reconstruction.
Who could benefit from this research? This method can aid radiologists and other medical doctors in two ways. First, it enables the reconstruction of very fine details on medical images that are potentially missed by other techniques, greatly improving the diagnostic value of such images. Second, as this method can recover high-quality images from accelerated measurements, the duration of MR scans can be greatly reduced. This may lead to more efficient utilization of the scanners and can bring down their high cost. Overall, the goal is to make MRI more reliable and efficient for everyone.
Liyu Chen (University of Southern California); Haipeng Luo (University of Southern California)
What is your paper about? This paper is about how an agent can learn to behave optimally in a changing environment. Recently Waymo launched an autonomous ride service to Phoenix airport. Training an autonomous driving car can be framed as a goal-oriented reinforcement learning problem, which falls into the framework studied in this paper. Moreover, this paper studied a non-stationary changing environment, which is suitable for capturing changing traffic conditions.
Learning about the world through language and vision
Tejas Srinivasan (University of Southern California), Ting-Yun Chang (University of Southern California), Leticia Leonor Pinto Alva (University of Southern California), Georgios Chochlakis (University of Southern California, ISI), Mohammad Rostami (University of Southern California), Jesse Thomason(University of Southern California)
What is your paper about? We establish a benchmark to study how models that consider both language and vision can learn tasks in sequence, such as answering open-ended questions about pictures versus answering yes/no questions about pairs of pictures. This benchmark also enables studying what happens when language or vision disappears, such as tasks like classifying whether movie reviews are positive or negative or identifying the salient object in an image.
Gabriele Farina (School of Computer Science, Carnegie Mellon University); Ioannis Anagnostides (Carnegie Mellon University); Haipeng Luo (University of Southern California); Chung-Wei Lee (University of Southern California); Christian Kroer (Columbia University); Tuomas Sandholm (Carnegie Mellon University)
Tiancheng Jin (University of Southern California); Tal Lancewicki (Tel Aviv University); Haipeng Luo (University of Southern California); Yishay Mansour (School of Computer Science, Tel Aviv University); Aviv Rosenberg (Amazon)
Ioannis Anagnostides (Carnegie Mellon University); Gabriele Farina (School of Computer Science, Carnegie Mellon University); Christian Kroer (Columbia University); Chung-Wei Lee (University of Southern California); Haipeng Luo (University of Southern California); Tuomas Sandholm (Carnegie Mellon University)
Zalan Fabian (University of Southern California); Berk Tinaz (University of Southern California); Mahdi Soltanolkotabi (University of Southern California)
Yu Cheng (Brown University); Ilias Diakonikolas (University of Wisconsin, Madison); Rong Ge (Duke University); Shivam Gupta (University of Texas, Austin); Daniel Kane (University of California-San Diego); Mahdi Soltanolkotabi (University of Southern California)
Huili Chen (University of California, San Diego); Jie Ding (University of Minnesota, Minneapolis); Eric William Tramel (Amazon); Shuang Wu (Amazon); Anit Kumar Sahu (Amazon Alexa AI); Salman Avestimehr (University of Southern California); Tao Zhang
Shushan Arakelyan (University of Southern California); Anna Hakhverdyan (National Polytechnic University of Armenia); Miltiadis Allamanis (Google); Luis Antonio Garcia (USC ISI); Christophe Hauser (USC/ISI); Xiang Ren (University of Southern California)
Bat-Sheva Einbinder (Technion – Israel Institute of Technology, Technion – Israel Institute of Technology); Yaniv Romano (Technion, Technion); Matteo Sesia (University of Southern California); Yanfei Zhou (University of Southern California)
Changyou Chen (State University of New York, Buffalo); Jianyi Zhang (Duke University); Yi Xu (Amazon); Liqun Chen (Duke University); Jiali Duan (University of Southern California); Yiran Chen (Duke University); Son Dinh Tran (University of Maryland, College Park); Belinda Zeng (Amazon); Trishul Chilimbi (Department of Computer Science, University of Wisconsin – Madison)
Hang Gao (University of California Berkeley); Ruilong Li (University of Southern California); Shubham Tulsiani (Carnegie Mellon University); Bryan Russell (Adobe Research); Angjoo Kanazawa (University of California, Berkeley)
Bill Yuchen Lin (University of Southern California); Kangmin Tan (University of Southern California); Chris Scott Miller (Dartmouth College); Beiwen Tian (Tsinghua University, Tsinghua University); Xiang Ren (University of Southern California)
Yan Dai (Institute for Interdisciplinary Information Sciences, Tsinghua University); Haipeng Luo (University of Southern California); Liyu Chen (University of Southern California)
Why housing alone is not enough for some homeless moms
Study finds women struggling with substance use need more help
COLUMBUS, Ohio – Giving some homeless mothers with young children a place to live may do little to help them if it is not combined with support services, a first-of-its-kind study showed.
Researchers found that young moms with a substance use disorder showed less improvement if they were given only housing when compared with similar moms who were given housing and supportive services, or even mothers who were only given a list of community services available to them.
That’s an important finding for organizations and policymakers who have advocated a “housing first” policy that aims to get the homeless into permanent housing as quickly as possible, said Natasha Slesnick, lead author of the study and professor of human sciences at The Ohio State University.
“Housing is still very important, but it is not enough,” Slesnick said.
“These young homeless moms need help accessing services and meeting their daily life needs or they may not be able to overcome their substance use.”
The study is the first in this area to use what is considered the “gold standard” in research: a randomized controlled trial.
Young homeless moms (age 18-24) with one or more children under the age of 6 who had a substance use disorder were randomly assigned to receive one of three treatments: the usual support services given in the community, housing only, or housing with support services.
The researchers recruited 240 women in Columbus from shelters, a drop-in center and other agencies serving homeless youth.
The one-third of participants who received housing and supportive services were given a voucher for independent housing and six months of supportive services, including strengths-based outreach and advocacy, HIV prevention, and substance use and mental health counseling.
Another third were only provided housing, while the remaining third were given “services as usual” – they received a referral sheet of all services available to them in the community, but where not offered housing or support services through the study.
At the beginning of the study – and every 3 months for one year– the participants completed measures of their substance use (including alcohol and illicit drugs) and their levels of self-efficacy – how much they felt they were in control of what happens in their life.
Overall, those in the housing and supportive services group fared the best and were most likely of all three groups to have low substance use and increasing self-efficacy by the end of the study, Slesnick said.
“It was encouraging that housing plus supportive services reduced substance use and helped them develop confidence in their ability to solve problems and address the daily hassles of life,” she said.
Women in the other two groups did show some improvements in lowering substance use and improving self-efficacy. But more mothers receiving only housing increased their substance use over time compared to those receiving services-as-usual or housing and support services.
“For those young mothers just given housing, they still have a lot of stress in their lives with a child under 6. And that stress is often going to lead them to cope how they typically do, which is often with substance use,” Slesnick said.
One reason that this study is so important is that mothers dealing with substance use disorders and homelessness are often difficult to help. In an earlier study that included focus groups with homeless mothers, Slesnick and her colleagues found that many of these women were reluctant to seek help, especially in shelters, because they feared their children would be taken away from them.
That’s a key reason why a “housing first” policy that keeps mothers with their children is important, but only if it provides help to deal with substance abuse and mental health issues and gives them other assistance to get their lives on track, Slesnick said.
“The conclusion is that we just can’t put these families into housing without supports. We need to provide services that will give them better ways to cope and offer a sense of self-efficacy to manage the daily stress of life without resorting to substance use.”
Co-authors on the study came from Ohio State, Kent State University, Florida State University and Nationwide Children’s Hospital in Columbus.
NIH/NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES
IMAGE: DR. ANTHONY FAUCI IN HIS OFFICE, 1984.view more
CREDIT: NIAID
Once considered a potentially static field of medicine, the discipline of studying infectious diseases has proven to be dynamic as emerging and reemerging infectious diseases present continuous challenges, Anthony S. Fauci, M.D., writes in a perspective in The New England Journal of Medicine. In the piece, Dr. Fauci, who since 1984 has directed the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, reflects on his career responding to infectious disease threats. Dr. Fauci will step down from his positions as NIAID director, chief of NIAID’s Laboratory of Immunoregulation and chief medical advisor to President Joe Biden in December 2022.
In the perspective, Dr. Fauci notes that the emergence of HIV/AIDS in 1981 led to a sharp increase in interest in infectious diseases among people entering the field of medicine. Since then, infectious disease specialists have faced numerous medical challenges, including the 2009 H1N1 influenza pandemic, Ebola, Zika, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and COVID-19, he writes.
Although COVID-19 was “the loudest wake-up call in more than a century to our vulnerability to outbreaks of emerging infectious diseases,” Dr. Fauci notes that one success of the response was the rapid development, testing and distribution of COVID-19 vaccines thanks to years of research and investment in new and highly adaptable vaccine platforms and structural biology tools to design vaccine immunogens. These technological advances, among others, will greatly benefit the field of infectious diseases, he writes. He concludes by stressing the importance of improving capabilities to respond to established infectious diseases like malaria and tuberculosis while also responding to emerging threats.
ARTICLE: AS Fauci. It Ain’t Over Till It’s Over…but It’s Never Over—Emerging and Reemerging Infectious Diseases. The New England Journal of Medicine DOI: 10.1056/NEJMp2213814 (2022).
WHO: Dr. Fauci is available for interviews.
CONTACT: To schedule interviews, please contact the NIAID News & Science Writing Branch, (301) 402-1663, niaidnews@niaid.nih.gov.
NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit https://www.nih.gov/.
A new WWARNmeta-analysis commissioned by the World Health Organization (WHO) which informed a change to its treatment guidelines* has been published in The Lancet. The study provides compelling evidence that artemether-lumefantrine should now replace quinine as the treatment of choice in the first trimester. Although there is limited data on specific artemisinin-based combination therapies (ACTs) other than artemether-lumefantrine, the other ACTs (including artesunate-amodiaquine, artesunate-mefloquine and dihydroartemisinin-piperaquine but not artesunate–sulfadoxine–pyrimethamine) may be considered for use where artemether-lumefantrine is not available, given the demonstrated poorer outcomes of quinine treatment, along with the challenges of adherence to a seven-day course of treatment.
ACTs are already recommended for treatment in second and third trimesters. This study, the largest of its kind, was a collaborative effort between over 20 research groups with data from over 34,000 pregnancies from 12 cohort studies in ten countries collected over more than 20 years.
Malaria in pregnancy has devastating consequences for both mother and fetus, requiring prompt and effective treatment. The risk of infection is highest in the first trimester when many pregnancies are yet to be protected by chemoprevention with intermittent preventive treatment (IPTp) which begins in the second trimester. Up until now, ACTs were recommended by the WHO as first-line treatment in all patient groups, except in first-trimester women, for whom quinine with clindamycin has been recommended due to concerns about the potential embryotoxicity of artemisinins.
The meta-analysis results suggest that first-trimester treatment with artemisinin-based treatment is as safe and possibly more effective than non-artemisinin-based treatments, including quinine-based regimens. Importantly, artemether-lumefantrine, the ACT with the most safety data, was associated with 42% fewer adverse pregnancy outcomes (pregnancy loss or major congenital malformations) than oral quinine in the first trimester.
Dr Stephanie Dellicour, Principal Research Associate at the Liverpool School of Tropical Medicine, said: “The results of this meta-analysis are very reassuring as studies have shown that many women are already being exposed to first-line ACT treatment in early pregnancy in malaria-endemic countries. This is partly due to a lack of awareness of pregnancy status by the patients or healthcare providers at the time of treatment and the fact that quinine and clindamycin are largely unavailable in health facilities in eastern and southern Africa.“
Dr Makoto Saito, Assistant Professor at The Institute of Medical Science, The University of Tokyo and part of the WorldWide Antimalarial Research Network, said: “At WWARN, we have previously shown that ACTs have a superior efficacy and much better tolerability and lower transmission risk after treatment than quinine. This new study provides an update on a previous study, confirming the evidence on safety in the first trimester using all the currently available clinical data.
“This study provides strong evidence to policy makers that ACTs should replace quinine-based regimens as the preferred treatment for uncomplicated falciparum malaria for everybody, including pregnant women in their first trimester.”
All participating research groups kindly agreed to share their individual patient data (IPD) of 34,178 pregnancies with WWARN. The data included 737 pregnancies with confirmed first-trimester exposure to artemisinin-based treatment and 1,076 with confirmed exposure to other antimalarials. It has taken over 20 years to collect these data, illustrating the difficulty of obtaining quality data on the safety of antimalarials in pregnancy.
Dr Dellicour added: “Going forward, innovative strategies are needed to fast-track robust evidence generation to support informed decisions on treatment in pregnant women by policy makers, healthcare providers and patients and ensure that this high-risk group has access to the best antimalarial treatment in a timely manner.”
This research was funded by the Medicines for Malaria Venture (MMV), the World Health Organization, and the Worldwide Antimalarial Resistance Network (WWARN), funded by the Bill and Melinda Gates Foundation.
Read the full paper, Pregnancy outcomes after first-trimester treatment with artemisinin derivatives versus non-artemisinin antimalarials: A systematic review and individual patient data meta-analysis, here.
Notes
* The WHO has updated their guidelines on the treatment of uncomplicated malaria in the first trimester (MagicApplink see section 5.2.1.4.1 Pregnant and lactating women):
About WWARN
Since 2009, the WorldWide Antimalarial Research Network (WWARN) has generated innovative tools and reliable evidence to inform the malaria community on the factors affecting the efficacy of antimalarial medicines. In the field of poverty-related infectious diseases, data are scarce and scattered across institutions around the world. WWARN collates and standardises anonymised individual patient data (IPD) from many trials and studies conducted across endemic regions so that they can then be harmonised and analysed as a single dataset, increasing the statistical power needed to answer key questions in malaria research.
Part of the Infectious Diseases Data Observatory (IDDO), WWARN’s repository holds over 200k IPD and shares the resulting evidence widely to inform both policymakers and future researchers globally to continually advance knowledge and build capacity for evidence-based practice. Find out more at info@wwarn.org.
About LSTM
The Liverpool School of Tropical Medicine (LSTM) is a higher education institution with degree awarding powers and a registered charity in Liverpool, United Kingdom. Established in 1898, it was the first institution in the world dedicated to research and teaching tropical medicine. LSTM is a leading global research institute with well-established African networks and leads numerous international consortia and product development partnerships aimed at reducing or eliminating the impact of diseases upon the world's poorest people.
Pregnancy outcomes after first-trimester treatment with artemisinin derivatives versus non-artemisinin antimalarials: a systematic review and individual patient data meta-analysis
